1. Whole-body MR imaging in suspected physical child abuse: comparison with skeletal survey and bone scintigraphy findings from the PEDIMA prospective multicentre study
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Proisy, Maïa, Vivier, Pierre-Hugues, Morel, Baptiste, Bruneau, Bertrand, Sembely-Taveau, Catherine, Vacheresse, Solène, Devillers, Anne, Lecloirec, Joseph, Bodet-Milin, Caroline, Dubois, Marine, Hamonic, Stéphanie, Bajeux, Emma, Ganivet, Anne, Adamsbaum, Catherine, Treguier, Catherine, Abalea, Lydie, Croly-Labourdette, Séverine, Dam Hieu, Phong, Dobrzynski, Murielle, Fenoll, Bertrand, Forlodou, Pierre, Le Bot, Christiane, Lefranc, Jérémie, Lesoeur, Mélanie, Mériot, Philippe, Peudenier, Sylviane, Querello, Solène, Salaun, Pierre Yves, Olivier, Pierre, Martrille, Laurent, Borsa-Dorion, Anne, Galloy, Marie-Agnès, Mainard-Simard, Laurence, Raffo, Emmanuel, Cavare-Vigneron, Sylvie, Claudon, Michel, Klein, Olivier, Schmitt, Emmanuelle, Le Tacon, Serge, Morel, Olivier, Lapp, Lucie, Bodere-Kraeber, Françoise, Milin, Caroline, Fleury, Juliette, Geffroy, Loïc, Hamel, Sophie, Lefrancois, Thomas, Longis, Marie-Pierre, Mayrargue, Emmanuelle, Picherot, Georges, Quéré, Marie-Pierre, Rozé, Jean-Christophe, Vabres, Nathalie, Bouvet, Renaud, Le Gueut, Mariannick, Riffaud, Laurent, Balençon, Martine, Bétrémieux, Pierre, Chapuis, Madeleine, Chasle, Véronique, Dabadie, Alain, Damaj, Léna, Darnault, Pierre, de La Brière, François, Delahaye, Séverine, Duvauferrier, Regis, Farges, Céline, Fraisse, Bernard, Gaillot, Théophile, Gardin, Maryse, Gauvrit, Cécile, Guitteny, Marie-Aline, Marleix, Sylvette, Napuri, Silvia, Roussey, Michel, Rozel, Céline, Tirel, Olivier, Vignaud, Catherine, Violas, Philippe, Wodey, Eric, Pierre, Marion, Pladys, Patrick, Abu-Amara, Saad, Bachy, Bruno, Brasseur-Daudruy, Marie, Dacher, Jean-Nicolas, Delmon, Pascal, Lechevallier-Amara, Joël, Lerebours, Bénédicte, Leroux, Julien, Proust, Francois, Rigal, Sophie, Baulieu, Jean-Louis, Venel, Yann, Elodie, Carpentier, Chantepie, Alain, Chantreuil, Julie, Come, Mathieu, de Courtivron, Benoit, Labarthe, François, Marot, Yves, Pepin-Donat, Myriam, Sirinelli, Dominique, Travers, Nadine, Urvois-Grange, Annie, O'Byrne, Patrick, Listrat, Antoine, Barge-Galern, Marie-Luce, Le Cloirec, Joseph, Vera, Pierre, Kone-Paut, I., Deiva, Kumaran, Chaumet-Riffaud, Philippe, Grimon, Gilles, Archambaud, Frederique, Zenkhri, Ferielle, Galeotti, Caroline, Sevette-Béchard, Nancy, Prodhomme, Olivier, Leconte, Céline, Haquet, Armelle, Bourdon, Aurélie, Sainmont, Mélanie, De-Pontual, Loic, Sellier, Nicolas, Trieu, Thanh-Van, de Labriolle-Vaylet, Claire, Département de Radiologie [Rennes], Université de Rennes (UR), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Département de médecine nucléaire [Rennes], CRLCC Eugène Marquis (CRLCC), Service de médecine nucléaire [Rouen], CRLCC Haute Normandie-Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen (CLCC Henri Becquerel), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Universitaire [Rennes], Département de Radiologie [AP-HP Hôpital Bicêtre], AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Montpellier (UM), PEDIMA study research group: Lydie Abalea, Séverine Croly-Labourdette, Phong Dam Hieu, Murielle Dobrzynski, Bertrand Fenoll, Pierre Forlodou, Christiane Le Bot, Jérémie Lefranc, Mélanie Lesoeur, Philippe Meriot, Sylviane Peudenier, Solène Querello, Pierre-Yves Salaun, Pierre Olivier, Laurent Martrille, Anne Borsa-Dorion, Marie-Agnès Galloy, Laurence Mainard-Simard, Emmanuel Raffo, Sylvie Cavare-Vigneron, Michel Claudon, Olivier Klein, Emmanuelle Schmitt, Serge Le Tacon, Olivier Morel, Lucie Lapp, Françoise Bodéré-Kraeber, Caroline Milin, Juliette Fleury, Loïc Geffroy, Sophie Hamel, Antoine Hamel, Thomas Lefrançois, Marie-Pierre Longis, Emmanuelle Mayrargue, Georges Picherot, Marie-Pierre Quéré, Jean-Christophe Rozé, Nathalie Vabres, Renaud Bouvet, Mariannick Le Gueut, Laurent Riffaud, Martine Balençon, Pierre Bétrémieux, Madeleine Chapuis, Véronique Chasle, Alain Dabadie, Léna Damaj, Pierre Darnault, François De La Brière, Séverine Delahaye, Régis Duvauferrier, Céline Farges, Bernard Fraisse, Théophile Gaillot, Maryse Gardin, Cécile Gauvrit, Marie-Aline Guitteny, Sylvette Marleix, Silvia Napuri, Michel Roussey, Céline Rozel, Olivier Tirel, Catherine Tréguier, Catherine Vignaud, Philippe Violas, Eric Wodey, Marion Pierre, Patrick Pladys, Saad Abu-Amara, Bruno Bachy, Marie Brasseur-Daudruy, Jean-Nicolas Dacher, Pascal Delmon, Joël Lechevallier Amara, Bénédicte Lerebours, Julien Leroux, François Proust, Sophie Rigal, Pierre-Hugues Vivier, Jean-Louis Baulieu, Yann Venel, Elodie Carpentier, Alain Chantepie, Julie Chantreuil, Mathieu Come, Benoît De Courtivron, François Labarthe, Yves Marot, Myriam Pepin Donat, Dominique Sirinelli, Nadine Travers, Annie Urvois-Grangé, Patrick O'Byrne, Antoine Listrat, Marie-Luce Barge-Galerne, Joseph Le Cloirec, Pierre Vera, Isabelle Koné-Paut, Kumaran Deiva, Philippe Chaumet-Riffaud, Gilles Grimon, Frédérique Archambaud, Ferielle Zenkhri, Caroline Galeotti, Nancy Sevette Béchard, Olivier Prodhomme, Céline Leconte, Armelle Haquet, Aurélie Bourdon, Mélanie Sainmont, Loïc De Pontual, Nicolas Sellier, Thanh-Van Trieu, Claire De Labriolle-Vaylet., Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA), and DACHER, Jean Nicolas
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Child abuse ,medicine.medical_specialty ,[SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging ,Skeletal survey ,[SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine ,Sensitivity and Specificity ,[SDV.IB.MN] Life Sciences [q-bio]/Bioengineering/Nuclear medicine ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,[SDV.MHEP.PED] Life Sciences [q-bio]/Human health and pathology/Pediatrics ,0302 clinical medicine ,parasitic diseases ,medicine ,Humans ,Whole Body Imaging ,Radiology, Nuclear Medicine and imaging ,Child Abuse ,Prospective Studies ,Child ,Radionuclide Imaging ,Neuroradiology ,[SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics ,medicine.diagnostic_test ,business.industry ,Infant ,Interventional radiology ,Magnetic resonance imaging ,General Medicine ,Magnetic Resonance Imaging ,Occult ,Confidence interval ,3. Good health ,[SDV.IB.IMA] Life Sciences [q-bio]/Bioengineering/Imaging ,Physical Abuse ,Bone scintigraphy ,030220 oncology & carcinogenesis ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
International audience; Objectives: To assess the contribution of whole-body magnetic resonance imaging (WBMRI) and bone scintigraphy (BS) in addition to skeletal survey (SS) in detecting traumatic bone lesions and soft-tissue injuries in suspected child abuse.Methods: In this prospective, multicentre, diagnostic accuracy study, children less than 3 years of age with suspected physical abuse were recruited. Each child underwent SS, BS and WBMRI. A blinded first review was performed in consensus by five paediatric radiologists and three nuclear medicine physicians. A second review investigated discrepancies reported between the modalities using a consensus result of all modalities as the reference standard. We calculated the sensitivity, specificity and corresponding 95% confidence interval for each imaging modality (SS, WBMRI and BS) and for the combinations [SS + WBMRI] and [SS + BS].Results: One hundred seventy children were included of which sixty-four had at least one lesion. In total, 146 lesions were included. The sensitivity and specificity of each examination were, respectively, as follows: 88.4% [95% CI, 82.0-93.1] and 99.7% [95% CI, 99.5-99.8] for the SS, 69.9% [95% CI, 61.7-77.2] and 99.5% [95% CI, 99.2-99.7] for WBMRI and 54.8% [95% CI, 46.4-63.0] and 99.7% [95% CI, 99.5-99.9] for BS. Sensitivity and specificity were, respectively, 95.9% [95% CI, 91.3-98.5] and 99.2% [95% CI, 98.9-99.4] for the combination SS + WBMRI and 95.2% [95% CI, 90.4-98.1] and 99.4% [95% CI, 99.2-99.6] for the combination SS + BS, with no statistically significant difference between them.Conclusion: SS was the most sensitive independent imaging modality; however, the additional combination of either WBMRI or BS examinations offered an increased accuracy.Key points: • SS in suspected infant abuse was the most sensitive independent imaging modality in this study, especially for detecting metaphyseal and rib lesions, and remains essential for evaluation. • The combination of either SS + BS or SS + WBMRI provides greater accuracy in diagnosing occult and equivocal bone injuries in the difficult setting of child abuse. • WBMRI is a free-radiation technique that allows additional diagnosis of soft-tissue and visceral injuries.
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- 2021